First, some patients are found to have lumbar spondylolisthesis degree II or III, what does this mean? Is surgery necessary at this level? Lumbar spondylolisthesis degree II and III are judged by imaging. The upper vertebral body slips forward or backward relative to the lower vertebral body, exceeding 1/4 but not 1/2 of the vertebral body surface is degree II, and exceeding 1/2 but not 3/4 is degree III, which can be commonly understood as moderate to severe spondylolisthesis. Is it time for surgery in this case? The decision depends on the patient’s symptoms, not that a degree II slippage requires surgery, but a degree I slippage does not. Some patients with degree I slippage have very serious neurological symptoms such as leg numbness and leg weakness, which also require surgery; while some patients with degree II slippage have tolerated the nerve compression for a long time, so the neurological symptoms of these patients are often very mild, and even the back is not particularly painful, so this case can be treated conservatively first, and there is no need to rush surgery. However, usually the slippage of degree II or above will be accompanied by symptoms of nerve compression, such as leg numbness and leg weakness, etc. If the nerve symptoms are very heavy, surgery needs to be considered. Second, many patients have symptoms of leg pain and numbness in addition to low back pain, and they have to stop and rest for a while before they can continue walking after walking a few hundred meters, why is this? Is surgery necessary at this point? In addition to low back pain, patients also have symptoms such as leg pain, leg numbness, and inability to walk long distances, and there is a clinical term to describe it, called intermittent claudication. This is a very typical clinical manifestation caused by spinal stenosis after lumbar spondylolisthesis. Patients are asymptomatic at first, but after walking a few hundred meters, they will experience leg pain, leg numbness, leg weakness, soreness, and inability to take steps, and have to rest for a period of time before they can continue walking again. This indicates that the nerves are dynamically compressed during the patient’s walking process, often suggesting that the patient’s lumbar spinal stenosis has become so severe that the nerves have “nowhere to hide” in the spinal canal and are often compressed until they cannot withstand the compression, thus producing the corresponding symptoms. Generally, as the degree of lumbar spinal slippage and spinal stenosis increases, the distance of claudication becomes shorter and shorter. If the symptoms of intermittent claudication continue to worsen, surgery should be considered. Third, some patients have significant back pain, and the examination reveals that in addition to lumbar spondylolisthesis, there is also the problem of disc bulge, what should be done in this case? Is not to surgery? Bulging discs and lumbar spondylolisthesis, as well as the abnormal manifestations of the spine found on imaging. Does this condition need to be treated or not? The key depends on whether the changes cause clinical symptoms and whether these clinical symptoms can be improved with conservative treatment. If a patient with a bulging disc can get better after conservative treatment, then surgery is not needed; if after a period of regular conservative treatment, the symptoms are still present or even getting worse, then surgery is required. Therefore, in general, the key to surgery depends on whether the patient has symptoms, the severity of the symptoms and whether they can improve through conservative treatment.